Mah Trina-Jo, Mallon Dermot H, Brewster Oliver, Saeb-Parsy Kourosh, Butler Andrew J, Bradley J Andrew, Kosmoliaptsis Vasilis
Department of Surgery, University of Cambridge, Cambridge, UK.
NIHR Cambridge Biomedical Research Centre, NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, UK.
Clin Transplant. 2017 Apr;31(4). doi: 10.1111/ctr.12912. Epub 2017 Feb 13.
A large increase in the use of kidneys from donation after circulatory death (DCD) donors prompted us to examine the impact of donor type on the incidence of ureteric complications (UCs; ureteric stenosis, urinary leak) after kidney transplantation. We studied 1072 consecutive kidney transplants (DCD n=494, live donor [LD] n=273, donation after brain death [DBD] n=305) performed during 2008-2014. Overall, there was a low incidence of UCs after kidney transplantation (3.5%). Despite a trend toward higher incidence of UCs in DCD (n=22, 4.5%) compared to LD (n=10, 3.7%) and DBD (n=5, 1.6%) kidney transplants, donor type was not a significant risk factor for UCs in multivariate analysis (DCD vs DBD HR: 2.33, 95% CI: 0.77-7.03, P=.13). There was no association between the incidence of UCs and donor, recipient, or transplant-related characteristics. Management involved surgical reconstruction in the majority of cases, with restenosis in 2.7% requiring re-operation. No grafts were lost secondary to UCs. Despite a significant increase in the number of kidney transplants from DCD donors, the incidence of UCs remains low. When ureteric complications do occur, they can be treated successfully with surgical reconstruction with no adverse effect on graft or patient survival.
循环死亡后器官捐献（DCD）供体肾脏使用量的大幅增加促使我们研究供体类型对肾移植后输尿管并发症（UCs；输尿管狭窄、尿漏）发生率的影响。我们研究了2008年至2014年期间连续进行的1072例肾移植手术（DCD组n = 494，活体供体[LD]组n = 273，脑死亡后器官捐献[DBD]组n = 305）。总体而言，肾移植后UCs的发生率较低（3.5%）。尽管与LD组（n = 10，3.7%）和DBD组（n = 5，1.6%）肾移植相比，DCD组UCs的发生率有升高趋势（n = 22，4.5%），但在多因素分析中，供体类型并非UCs的显著危险因素（DCD组与DBD组的风险比：2.33，95%置信区间：0.77 - 7.03，P = 0.13）。UCs的发生率与供体、受体或移植相关特征之间无关联。多数病例的处理包括手术重建，2.7%的再狭窄病例需要再次手术。没有移植物因UCs而丢失。尽管DCD供体的肾移植数量显著增加，但UCs的发生率仍然较低。当确实发生输尿管并发症时，可通过手术重建成功治疗，且对移植物或患者生存无不良影响。
